Download PDF
J Neurol Surg A Cent Eur Neurosurg 2020; 81(03): 207-212
DOI: 10.1055/s-0039-1685513
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Endovascular Retreatment of Cerebral Aneurysms Previously Treated with Endovascular Embolization

Hui Li   *
1   Department of Neurosurgery, The First Hospital, Hebei Medical University, Shijiazhuang, Hebei Province, China
,
Bu-Lang Gao  ‡   *
1   Department of Neurosurgery, The First Hospital, Hebei Medical University, Shijiazhuang, Hebei Province, China
2   Department of Medical Research, Shijiazhuang First Hospital, Shijiazhuang, Hebei Province, China
,
Cong-Hui Li
1   Department of Neurosurgery, The First Hospital, Hebei Medical University, Shijiazhuang, Hebei Province, China
,
Ji-Wei Wang
1   Department of Neurosurgery, The First Hospital, Hebei Medical University, Shijiazhuang, Hebei Province, China
,
Jian-Feng Liu
1   Department of Neurosurgery, The First Hospital, Hebei Medical University, Shijiazhuang, Hebei Province, China
,
Song-Tao Yang
1   Department of Neurosurgery, The First Hospital, Hebei Medical University, Shijiazhuang, Hebei Province, China
› Author Affiliations
Further Information

Publication History

19 June 2018

07 February 2019

Publication Date:
19 November 2019 (online)

Also available at
    Permissions and Reprints

Abstract

Objective Intracranial aneurysms treated with endovascular coil embolization may recur. We investigated the factors affecting aneurysmal recurrence after embolization and effects of endovascular retreatment within 1 year.

Methods In 3 years, 1,335 patients with 1,385 intracranial aneurysms were treated with coil embolization. Factors affecting aneurysm recurrence and the effects of endovascular retreatment were analyzed.

Results Angiography immediately following embolization showed total occlusion in 1,030 aneurysms (74.4%), neck remnant in 207 (14.9%), and partial occlusion in 148 (10.7%), with a total peri-procedure complication rate of 4.2%. Overall, 145 patients with 151 aneurysms recurred within 1 year and the other 1,234 aneurysms remained occluded (89.1%). A significant (p < 0.05) difference existed in aneurysm size, rupture status, use of stent and immediate occlusion outcome between the two groups, with significantly (p < 0.05) lower recurrence rates in aneurysms with smaller sizes, no rupture and stent-assistance coiling. Neck remnant, partial occlusion, coiling without stent assistance, large and giant aneurysms were significant (p < 0.05) risk factors for aneurysm recurrence during the first year. The rate of recurrence was 4.7% (11/232) in aneurysms with total occlusion and 35.9% (23/64) in aneurysms with neck remnant and partial occlusion. Of the 34 recurrent aneurysms, 6 were re-embolized with detachable coils alone, 12 with stent-assisted coiling, 8 with balloon-assisted embolization, and the remaining 8 aneurysms with covered stents, resulting in total occlusion in 28 aneurysms and neck remnant in 6.

Conclusion Recurrence of previously-coiled cerebral aneurysms is significantly affected by aneurysm size, use of stent and degree of immediate occlusion. Endovascular retreatment with balloon-or stent-assisted techniques or with covered stents can be safe and effective for recurrent cerebral aneurysms.

Keywords

intracranial aneurysms - endovascular embolization - recurrence - endovascular retreatment - complications

* These authors contributed equally to this work.


 

  • References

  • 1 Guglielmi G, Viñuela F, Dion J, Duckwiler G. Electrothrombosis of saccular aneurysms via endovascular approach. Part 2: Preliminary clinical experience. J Neurosurg 1991; 75 (01) 8-14
    CrossrefPubMedSearch in Google Scholar
  • 2 Kim ST, Baek JW, Lee WH. , et al. Causes of early rebleeding after coil embolization of ruptured cerebral aneurysms. Clin Neurol Neurosurg 2018; 174: 108-116
    CrossrefPubMedSearch in Google Scholar
  • 3 Molyneux AJ, Kerr RS, Yu LM. , et al; International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group. International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 2005; 366 (9488): 809-817
    CrossrefPubMedSearch in Google Scholar
  • 4 Toyota S, Kumagai T, Goto T, Mori K, Taki T. Clipping of recurrent cerebral aneurysms after coil embolization. Acta Neurochir Suppl (Wien) 2018; 129: 53-59
    PubMedSearch in Google Scholar
  • 5 Dinç H, Öztürk MH, Sari A, Çakir E, Gazioğlu G, Kuzeyli K. Coil embolization in 481 ruptured intracranial aneurysms: angiographic and clinical results. Diagn Interv Radiol 2013; 19 (02) 165-172
    PubMedSearch in Google Scholar
  • 6 Raymond J, Guilbert F, Weill A. , et al. Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke 2003; 34 (06) 1398-1403
    CrossrefPubMedSearch in Google Scholar
  • 7 Plowman RS, Clarke A, Clarke M, Byrne JV. Sixteen-year single-surgeon experience with coil embolization for ruptured intracranial aneurysms: recurrence rates and incidence of late rebleeding. Clinical article. J Neurosurg 2011; 114 (03) 863-874
    PubMedSearch in Google Scholar
  • 8 Sluzewski M, van Rooij WJ, Slob MJ, Bescós JO, Slump CH, Wijnalda D. Relation between aneurysm volume, packing, and compaction in 145 cerebral aneurysms treated with coils. Radiology 2004; 231 (03) 653-658
    CrossrefPubMedSearch in Google Scholar
  • 9 Vanzin JR, Mounayer C, Abud DG, D'agostini Annes R, Moret J. Angiographic results in intracranial aneurysms treated with inert platinum coils. Interv Neuroradiol 2012; 18 (04) 391-400
    CrossrefPubMedSearch in Google Scholar
  • 10 Ogilvy CS, Chua MH, Fusco MR. , et al. Validation of a system to predict recanalization after endovascular treatment of intracranial aneurysms. Neurosurgery 2015; 77 (02) 168-173 ; discussion 173–174
    CrossrefPubMedSearch in Google Scholar
  • 11 Gallas S, Pasco A, Cottier JP. , et al. A multicenter study of 705 ruptured intracranial aneurysms treated with Guglielmi detachable coils. AJNR Am J Neuroradiol 2005; 26 (07) 1723-1731
    PubMedSearch in Google Scholar
  • 12 Murayama Y, Nien YL, Duckwiler G. , et al. Guglielmi detachable coil embolization of cerebral aneurysms: 11 years' experience. J Neurosurg 2003; 98 (05) 959-966
    PubMedSearch in Google Scholar
  • 13 Thornton J, Debrun GM, Aletich VA, Bashir Q, Charbel FT, Ausman J. Follow-up angiography of intracranial aneurysms treated with endovascular placement of Guglielmi detachable coils. Neurosurgery 2002; 50 (02) 239-249 ; discussion 249–250
    PubMedSearch in Google Scholar
  • 14 Li MH, Gao BL, Fang C. , et al. Angiographic follow-up of cerebral aneurysms treated with Guglielmi detachable coils: an analysis of 162 cases with 173 aneurysms. AJNR Am J Neuroradiol 2006; 27 (05) 1107-1112
    PubMedSearch in Google Scholar
  • 15 Henkes H, Fischer S, Weber W. , et al. Endovascular coil occlusion of 1811 intracranial aneurysms: early angiographic and clinical results. Neurosurgery 2004; 54 (02) 268-280 ; discussion 280–285
    CrossrefPubMedSearch in Google Scholar
  • 16 Phatouros CC, McConachie NS, Jaspan T. Post-procedure migration of Guglielmi detachable coils and mechanical detachable spirals. Neuroradiology 1999; 41 (05) 324-327
    CrossrefPubMedSearch in Google Scholar
  • 17 Geyik S, Yavuz K, Ergun O, Koc O, Cekirge S, Saatci I. Endovascular treatment of intracranial aneurysms with bioactive Cerecyte coils: effects on treatment stability. Neuroradiology 2008; 50 (09) 787-793
    CrossrefPubMedSearch in Google Scholar
  • 18 Renowden SAKP, Koumellis P, Benes V, Mukonoweshuro W, Molyneux AJ, McConachie NS. Retreatment of previously embolized cerebral aneurysms: the risk of further coil embolization does not negate the advantage of the initial embolization. AJNR Am J Neuroradiol 2008; 29 (07) 1401-1404
    CrossrefPubMedSearch in Google Scholar
  • 19 Campi A, Ramzi N, Molyneux AJ. , et al. Retreatment of ruptured cerebral aneurysms in patients randomized by coiling or clipping in the International Subarachnoid Aneurysm Trial (ISAT). Stroke 2007; 38 (05) 1538-1544
    CrossrefPubMedSearch in Google Scholar
  • 20 Kai Y, Hamada J, Morioka M. , et al. Re-treatment of patients with embolized ruptured intracranial aneurysms. Surg Neurol 2007; 70: 378-385
    PubMedSearch in Google Scholar
  • 21 Kang HS, Han MH, Kwon BJ, Kwon OK, Kim SH. Repeat endovascular treatment in post-embolization recurrent intracranial aneurysms. Neurosurgery 2006; 58 (01) 60-70 ; discussion 60–70
    CrossrefPubMedSearch in Google Scholar
  • 22 Cay F, Peker A, Arat A. Stent-assisted coiling of cerebral aneurysms with the Neuroform Atlas stent. Interv Neuroradiol 2018; 24 (03) 263-269
    CrossrefPubMedSearch in Google Scholar
  • 23 Kadkhodayan Y, Somogyi CT, Cross III DT. , et al. Technical, angiographic and clinical outcomes of Neuroform 1, 2, 2 Treo and 3 devices in stent-assisted coiling of intracranial aneurysms. J Neurointerv Surg 2012; 4 (05) 368-374
    CrossrefPubMedSearch in Google Scholar
  • 24 Wang C, Tian Z, Liu J. , et al. Flow diverter effect of LVIS stent on cerebral aneurysm hemodynamics: a comparison with Enterprise stents and the Pipeline device. J Transl Med 2016; 14 (01) 199
    CrossrefPubMedSearch in Google Scholar
  • 25 Gao BL, Li TX, Li L, Xu GQ, Yang BW. Tiny cerebral aneurysms can be treated safely and effectively with low-profile visualized intraluminal support stent-assisted coiling or coiling alone. World Neurosurg 2018; 113: e426-e430
    CrossrefPubMedSearch in Google Scholar
  • 26 Alexander MJHR, Smith TP, Tucci DL. Treatment of an iatrogenic petrous carotid artery pseudoaneurysm with a Symbiot covered stent: technical case report. Neurosurgery 2002; 50 (03) 658-662
    PubMedSearch in Google Scholar
  • 27 Amar APTG, Teitelbaum GP, Giannotta SL, Larsen DW. Covered stent-graft repair of the brachiocephalic arteries: technical note. Neurosurgery 2002; 51 (01) 247-252 ; discussion 252–253
    CrossrefPubMedSearch in Google Scholar
  • 28 Felber S, Henkes H, Weber W, Miloslavski E, Brew S, Kühne D. Treatment of extracranial and intracranial aneurysms and arteriovenous fistulae using stent grafts. Neurosurgery 2004; 55 (03) 631-638 ; discussion 638–639
    CrossrefPubMedSearch in Google Scholar
  • 29 Joo JYAJ, Ahn JY, Chung YS. , et al. Therapeutic endovascular treatments for traumatic carotid artery injuries. J Trauma 2005; 58 (06) 1159-1166
    CrossrefPubMedSearch in Google Scholar
  • 30 Kocer N, Kizilkilic O, Albayram S, Adaletli I, Kantarci F, Islak C. Treatment of iatrogenic internal carotid artery laceration and carotid cavernous fistula with endovascular stent-graft placement. AJNR Am J Neuroradiol 2002; 23 (03) 442-446
    PubMedSearch in Google Scholar
  • 31 Li MH, Gao BL, Wang YL, Fang C, Li YD. Management of pseudoaneurysms in the intracranial segment of the internal carotid artery with covered stents specially designed for use in the intracranial vasculature: technical notes. Neuroradiology 2006; 48 (11) 841-846
    CrossrefPubMedSearch in Google Scholar
  • 32 Redekop G, Marotta T, Weill A. Treatment of traumatic aneurysms and arteriovenous fistulas of the skull base by using endovascular stents. J Neurosurg 2001; 95 (03) 412-419
    PubMedSearch in Google Scholar
  • 33 Saatci I, Cekirge HS, Ozturk MH. , et al. Treatment of internal carotid artery aneurysms with a covered stent: experience in 24 patients with mid-term follow-up results. AJNR Am J Neuroradiol 2004; 25 (10) 1742-1749
    Search in Google Scholar
  • 34 Saket RR, Razavi MK, Sze DY, Frisoli JK, Kee ST, Dake MD. Stent-graft treatment of extracranial carotid and vertebral arterial lesions. J Vasc Interv Radiol 2004; 15 (10) 1151-1156
    CrossrefPubMedSearch in Google Scholar